In Breastfeeding, What's Best?

Breastfeeding can be stressful. Even after learning to breastfeed, which is a challenge for many, new mothers struggle to keep it up for the recommended six months -- especially if they return to work. But a group of UK researchers are now questioning the guidelines on how long mothers should breastfeed, adding uncertainty into an already stressful debate.

In an editorial published in the British Medical Journal, Dr. Mary Fewtrell, from the University College London Institute of Child Health, and colleagues argue that babies who are breastfed exclusively for six months are at a higher risk for iron deficiency and food allergies including celiac disease. They also suggest that waiting six months to introduce weaning foods can lead to the underdevelopment of taste, which might have long-term implications on diet.

"In the West, any proposed beneficial effects of exclusive breast feeding to six months on infection risk would need to be weighed against plausible, or at least suggestive, evidence for adverse effects," the authors reported.

Three of the four authors acknowledged having consulted or received research funding within the past three years from companies that manufacture infant formulas and baby foods.

The editorial spawned criticism from pediatricians and lactation specialists, who adamantly believe that exclusive breastfeeding for six months is the gold standard in neonatal nutrition.

"We in lactation and breastfeeding medicine have worked hard over the past 10 years literally fighting both our medical colleagues who are not educated in lactation, and our culture, to establish exclusive breastfeeding for the first six months as the evidence-based norm and standard of care for virtually every baby," said Dr. Kathleen Marinelli, a pediatrician at Connecticut Children's Medical Center and associate professor of pediatrics at the University of Connecticut School of Medicine.

Although 75 percent of new moms in the U.S. start breastfeeding, only 13 percent are still breastfeeding exclusively at six months, according to the CDC. Advocacy groups have pushed for better resources and support to make six months of breastfeeding more feasible for new moms, many of whom return to work less than six weeks after giving birth.

"When mothers 'can't' breastfeed, it is almost always because the supports were not in place for her to do it, and those supports come from society and the health care profession," said Marinelli.

What is the Evidence?

The editorial stressed the need for more evidence-based recommendations on breastfeeding duration, explaining that the current guidelines -- such as those adopted by the American Academy of Pediatrics -- are based on small observational studies instead of properly designed trials.

"Many studies in our field are small and flawed, because it is difficult to do large-scaled, ethical randomized controlled trials of infant feeding. So we are left designing the best trials we can, and looking at retrospective data, and data collected as part of large governmental surveys, and doing our best to ferret out what it really means," said Marinelli. "The strength comes when we have large numbers of these trials and we can look at them together. And in that way, the data supports exclusive breastfeeding for six months."